风湿

白介素6和IgA型类风湿因子与早期类风湿的基线骨侵蚀相关

作者:Fedele AL,et al. 翻译:北医三院赵金霞 审校:柴静 来源:中国风湿病公众论坛 日期:2018-04-25
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         白介素6和IgA型类风湿因子与早期类风湿的基线骨侵蚀相关

        摘要:

         目的:确定与血清阳性和阴性早期类风湿关节炎基线时骨侵蚀,预后和放射学进展相关的临床和免疫学特征[抗瓜氨酸化多肽抗体(ACPAs), 免疫球蛋白IgM (IgM)- 和IgA-类风湿因子 (RF), 和白介素6水平]。

        方法:本研究纳入408例早期类风湿关节炎患者,根据目标治疗策略每3个月随访评估一次。分别于基线和12个月后,进行手和足影像学检查Sharp/van der Heijde侵蚀评分。

        结果:血清阴性患者在疾病确诊时年龄和疾病活动度评分(DASs)更高于血清阳性患者。基线时IgA-RF阳性和IL-6血浆水平≥7.6 pg/mL的患者骨侵蚀风险更高,尤其二者同时存在时。多因素分析显示,病程和IL-6血浆水平≥7.6 pg/mL是诊断时存在骨侵蚀的独立危险因素。11.1%的早期类风湿关节炎患者在随访1年时发生放射学进展,ACPA阳性和诊断时年龄大是发生放射学进展的预测因素。虽然达到EULAR反应良好,DAS和Boolean缓解的患者比例在血清阳性和阴性,以及有骨侵蚀和无骨侵蚀的患者中相似,诊断时具有骨侵蚀,IgA–RF阳性,同时基线时IL-6 血浆水平≥7.6 pg/mL的患者在12个月后应用肿瘤坏死因子拮抗剂治疗的力度更大。

        结论:IgA-RF 阳性和IL-6血浆水平是基线时骨侵蚀的关键因素,而ACPA阳性是早期类风湿关节炎放射学进展的最强危险因素。

        附原文 Abstract OBJECTIVES:To define baseline clinical and immunological characteristics [anti-citrullinated peptide antibodies (ACPAs), immunoglobulin M (IgM)- and IgA-rheumatoid factor (RF), and interleukin-6 (IL-6) levels] involved in determining baseline erosiveness, outcome, and radiographic progression among seropositive and seronegative early rheumatoid arthritis (ERA) patients.METHOD:The 408 ERA patients enrolled in the study were monitored every 3 months according to the treat-to-target strategy. At baseline and after 12 months, hand and foot radiographs were evaluated using the Sharp/van der Heijde erosion score.RESULTS:At diagnosis, seronegative patients were older and had higher Disease Activity Scores (DASs) than seropositive patients. A higher risk of erosiveness at baseline was conferred by IgA-RF positivity and IL-6 plasma levels ≥7.6 pg/mL, particularly when simultaneously present. In multivariate analysis, disease duration and IL-6 plasma levels ≥7.6 pg/mL arose as independent variables associated with presence of erosions at onset. Radiographic progression at 1 year follow-up, which occurred in 11.1% of ERA patients, was predicted by ACPA positivity, together with higher age at diagnosis. Despite similar percentages of good European League Against Rheumatism response, DAS and Boolean remission being observed over time among seropositive and seronegative patients and between erosive and non-erosive subjects, ERA patients who were erosive at onset, IgA-RF seropositive, and simultaneously having high baseline IL-6 plasma levels (≥7.6 pg/mL) were treated to a greater extent with tumour necrosis factor blockers after 12 months.CONCLUSION:IgA-RF positivity and IL-6 plasma levels are crucial for baseline erosiveness, while ACPA positivity represents the strongest risk factor for developing radiographic progression in ERA.

        引自:Fedele AL,Petricca L,Tolusso B,Alivernini S, et al.Interleukin-6 and IgA-rheumatoid factor are crucial for baseline erosiveness, and anti-citrullinated peptide antibodies for radiographic progression in early rheumatoid arthritis treated according to a treat-to-target strategy.Scand J Rheumatol. 2018 Mar 15:1-9.doi: 10.1080/03009742.2017.1416668. [Epub ahead of print]

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